FPF040

FOR HDMF USE ONLY

EMPLOYER’S DATA Pag-IBIG EMPLOYER’S ID NUMBER

FORM (EDF) REGISTRATION TRACKING NUMBER

INSTRUCTIONS
1. Accomplish this form in two (2) copies.
2. Type or print all entries in BLOCK and CAPITAL LETTERS.
3. On the “CONTACT DETAILS” portion, indicate at least one (1) contact number.
4. On the “INDUSTRY” portion, indicate industry based on the provided List of Industry.
5. Submit duly accomplished form together with required supporting documents based on the Employer’s Registration Checklist of Requirements (FPF030).

EMPLOYER/BUSINESS NAME

EMPLOYER/BUSINESS ADDRESS CONTACT DETAILS

Unit/Room No., Floor Building Name COUNTRY + AREA CODE TELEPHONE NUMBER
Business (Direct Line)

Lot No. Block No. Phase No. House No. Street Name
Business (Fax)
Subdivision Barangay
Business (Trunkline) Local

Municipality/City Province ZIP Code

Business Email Address

EMPLOYER/BUSINESS DETAILS
START OF BUSINESS OPERATION INDUSTRY PHILIPPINE BUSINESS REGISTRY No. DATE OF
ISSUANCE
m m d d y y y y
BRANCH/OFFICE WITH RETIREMENT PLAN SEC REGISTRATION/ DATE OF

Head Office
Yes CDA CERTIFICATE No. ISSUANCE

Branch (Please Specify) _________________
No
TYPE OF EMPLOYER TAXPAYERS IDENTIFICATION NUMBER (TIN)

Private
Government
Household

For Private Employers For Private Employers

LEGAL PERSONALITY

Sole Proprietorship

Partnership
For Government Employers
CLASSIFICATION

National Government

Local Government Unit (LGU)

Constitutional Office
SSS No.

Corporation
Cooperative/Trade

Foreign-owned Corporation Association
For Government Employers
GSIS BUSINESS PARTNER No.

Government-Owned and
Controlled Corporation (GOCC)/
Government Financial Institution (GFI) AGENCY/BRANCH/DIVISION CODE

PREVIOUS EMPLOYER/BUSINESS NAME (If applicable)

CERTIFICATION
I hereby certify that the information given and all statements made herein are true and correct to the best of my knowledge and
belief. I further certify that my signature appearing herein is genuine and authentic.

__________________________________________ ___________________________ ____________________

Head of Office/Authorized Representative Designation/Position Date
(Signature over Printed Name)

FOR HDMF USE ONLY

RECEIVED BY DATE APPROVED BY DATE

Revised 03/2011
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.